- 1. TOPICS INMENS HEALTH Marcos Pienasola PA-S
2. LEARNING OBJECTIVES Outline some of the health problems
specific to men. Common terminology pertinent to caring for such
problems. Basic anatomy, physiology and pathophysiology of
commonconditions affecting men. Diagnostic studies and treatments
available. 3. TOPICS INMENS HEALTH Across a broad range of
indicators, men report poorer health than women. Although men in
all socioeconomic groups are doing poorly in terms of health, some
especially high-riskgroups include men of low socioeconomic status
(SES) of all racial/ ethnic backgrounds, low-SES minority men, and
middle-class African American men. David Williams, PhD, MPH 4. WHY
MENS HEALTH? Life expectancy shorter than women(75.6 years vs.
80.8.1 years) More likely to die at earlier ages from: Chronic
diseases (heart disease, CA, stroke) Communicable diseases Injuries
(both accidents and homicides) Highest-income men have mortality
rates equal to those of thepoorest women (Rieker and Bird 2000) 5.
DIAGNOSIS ADDRESSED TODAYBPHProstate cancerTesticular
cancerColorectal cancer 6. BPH WHAT IS IT? Benign prostatic
hyperplasia (BPH) is an enlarged prostate gland. BPH occurs in
almost all men as they age. BPH is not cancer .An enlarged prostate
can be a nuisance, but it is usually not aserious problem. About
half of all men older than 75 have some symptoms. Benign prostatic
hyperplasia is also known as benign prostatic hypertrophy. 7.
PROSTATE 8. CAUSES AND SYMPTOMS Causes: Not really sure. Better
understanding of risk factors Advanced age Obesity FmHx of
BPHSymptoms: Obstructive Irritative Hesitancy Intermittent voiding
Urgency Diminished stream Frequency Incomplete bladder Nocturia
emptying Postvoid leakage 9. WHAT BPH DOES NOT DO: does not cause
prostate cancer does not affect a mans ability to father children.
does not cause erectile dysfunction. 10. BPH DIAGNOSIS AND
TREATMENT How is BPH diagnosed? Present + past health history and a
physical exam. Tests may include Urine test (urinalysis) Blood
tests Digital rectal exam How is it treated? Treatment may not be
necessary unless the symptoms are bothersome enough or there are
other problems such as backed-up urine, bladder infections or
bladder stones. 11. BPH TreatmentMedical therapy HerbalWatchfull
Alpha blockerspreparations:waiting. Alpha reductaseinhibitorsSaw
Palmetto 12. PROSTATE CANCER 13. PROSTATE CANCERMost common cancer
found in American menafter skin cancer.It tends to be a
slow-growing cancer, butthere are also aggressive, fast-growing
types.Highly treatable with early detection. 14. RISK FACTORS
Advancing age African Americans FmHx of Prostate cancer Geneticfs
Possible risk factors Obesity Fatty diet Red meats 15. SYMPTOMS AND
SIGNS Very similar to BPH, including asymptomatic. Signs Nodular
posterior prostate Hard in consistency Irregular shape Other
associated with CA Coagulopathy Spinal cord compression 16.
PROSTATE CANCER - TESTINGDRE - digital rectal examPSA - prostate
specific antigenDiscussions at age: 50 for average-risk men 45 for
men at high risk. This includesAfrican-Americans. 40 for men with a
strong family history of prostate cancer. 17. PROSTATE CANCER - +
PSA F/UTRUSAbdominalMRI CTBoneScans 18. ELEVATED PSA DDX BPH Post
Prostate biopsies Prostatitis Post DRE Prostate Cancer 19.
TESTICULAR CANCER Uncommon cancer Usually curable Most occurrences
between ages15 and 35. Whites > African american 20. TESTICULAR
CANCER RISK FACTORS No one cause has been determined but there are
know linksbetween testicular cancer and other factors. Undescended
testicle (cryptorchidism). Personal history of testicular cancer.
Infertility Klinefelters syndrome and Downs syndrome. Smoking
Suspected risk factors: sedentary lifestyle, early puberty,
previous mumps,testicular injury, elevated scrotal temperature, and
overexposure to pesticidesor radiation. 21. SIGNS,SYMPTOMS AND
WORKUP Classic presentation: Painless testicular mass. Other sxs
occur in special circumstances A testicular mass should be
considered cancer until proven otherwise. Testicular exam during
CPE US recommended for any suspicious masses or persistentpainful
testicular swelling . Lab work you may come across hCG, LDH, AFP
22. PREVENTION Noncancerous growths in the testicle are rare, so
all masses should be assumed to be a cancer until proven otherwise.
23. WHAT IS COLORECTAL CANCER? Colon cancer vs rectal cancer. Most
arise from polyps 2nd highest cause of cancer death. Generally >
50 y/o More common and more morbidamongst African Americans Higher
mortality in males (43%) 24. RISK FACTORS Older than 60 African
American and eastern European descent History of cancer Colorectal
polyps Have inflammatory bowel disease Family history of colon
cancer Genetic syndromes: hereditary nonpolyposis colorectal cancer
(HNPCC) Familial adenomatous polyposis (FAP). Diet: animal fat
Obesity, smoking cigarettes and drinking alcohol. 25. SYMPTONS Many
asymptomatic Abdominal pain and tenderness in the lower abdomen
Blood in the stool (hematochezia) Dark, tarry stools (melena)
Diarrhea, constipation, or other change in bowel habits Intestinal
obstruction Narrow stools Unexplained anemia Weight loss w/o other
identifiable cause 26. TESTS AND DIAGNOSISPhysical exam May reveal
abdominal mass DREFOBT: Fecal occult blood testColonoscopy vs
Sigmoidoscopy biopsyBlood tests: Complete blood count (CBC) Liver
function tests CEA, CA19-9 (tumor markers)CT or MRI scans of the
abdomen, pelvic area, chest, or brain may beused to stage the
cancer. 27. TREATMENT AND PREVENTION Treatment Treatment depends
partly on the stage of the cancer. In general, treatments
mayinclude: Chemotherapy Surgery Radiation Prevention: Screening:
Statins Colonoscopy >50 y/o Dietary and lifestyle modifications
DRE age 40 are important. Removal of precancerous polyps Folic
acid, Calcium, fiber NSAIDs may help reduce the risk of colorectal
cancer. 28. TEN LEADING CAUSES OF DEATH IN MEN Heart disease Cancer
(lung, prostate, colorectal, skin) Stroke Accidents and
unintentional injuries Lung disease Diabetes Pneumonia and
influenza Suicide Chronic liver disease and cirrhosis Kidney
disease 29. References American Cancer Society MerkMedicus
www.emedicine.com Harrisons Medicine Practice Manual Epocrates
Prostate Cancer Foundation www. mayoclinic.org
